Unemployment has previously been found to have a strong connection with health and well-being. A new study published in JAMA Opthalmology has examined one aspect of this relationship, reporting on the association of vision loss and employment status.

The American Psychological Association (APA) state that unemployed workers are twice as likely to experience psychological problems such as anxiety, depression, low self-esteem and psychosomatic symptoms than those in employment.

Authors of the new study state that, as well as non-working individuals having poorer mental health and less social integration, previous studies have suggested that it is unlikely that visually impaired individuals are employed.

These studies, however, were limited by bias arising from using data that was not population-based, relying on self-reporting of visual impairment and failing to adhere to a clearly defined definition of visual impairment. These limitations left room for further research to be carried out.

A nationally representative study

The study was the first to utilize clearly defined categories of visual acuity when examining the work status of participants.

The study, funded by the National Institutes of Health and Research to Prevent Blindness, is the first study to have used defined objective criteria to describe visual impairment alongside work patterns in a population-based sample of individuals.

The researchers analyzed participants in the 1999-2008 National Health and Nutrition Examination Survey who completed a vision examination and employment/demographic questionnaires. For the study, 19,849 people aged 16-74 years took part.

Upon presentation, visual acuity was clearly defined into three groups:

Normal vision: 20/40 vision or better in the better seeing eye.

Uncorrected refractive error (URE): worse than 20/40 on presentation, but improving to 20/40 after auto-refraction.

Visual impairment: worse than 20/40 in the better seeing eye after auto-refraction.

Participants who responded negatively to the question, "With both eyes open, can you see light?" were not included in the researchers' analysis.

Employment status was also distinctly categorized. Working participants were categorized as either working full time or part time (working less than 35 hours a week), and non-working participants were defined as unemployed (if seeking for work or on layoff) or not in the labor force if the individual was neither seeking work nor on layoff.

The researchers found that employment rates were higher for both men and women with normal vision. The employment rates that were recorded were as follows:

Normal vision: men 76.2%, women 62.9%

URE: men 66.5%, women 56%

Visual impairment: men 58.7%, women 24.5%.

Visually impaired 'less likely to be working'

The authors report that visually impaired people are less likely to be working but not more likely to be unemployed. This distinction suggests that people with visual impairment are likely to either never enter or drop out of the labor force.

The results also showed that the likelihood of not working for participants with visual impairment was greater for women, people with diabetes and individuals aged below 55.

The authors acknowledge that the cross-sectional nature of their study means that it is difficult for them to conclude visual impairment has a causative effect on work status, saying that it is possible that work status could have a causative effect on vision. URE could occur as a result of the limited income that accompanies not working.

Although the study does not confirm what factor is causative in this equation, it does highlight the fact that there is a low frequency of employment among the visually impaired. The authors suggest that job training and employment promotion strategies are required, along with specific focuses on high-risk groups:

"Specific consideration should be given to populations at particularly higher risk of not working including women, individuals with diabetes mellitus, and those younger than 55 years. Additional studies should focus on why current strategies are ineffective and/or underused."

If work status does have a causative effect on vision, then there is some good news; the US Bureau of Labor Statistics (BLS) recently reported that during the past month, the unemployment rate declined by 0.2 percentage point to 6.1%.

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